| NPI | 1164916532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95061187) |
| Additional Taxonomies | 174H00000X Health Educator |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2020-02-12 |